Provider Demographics
NPI:1497815864
Name:BERMAN, ELAINE SANDRA (EDD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:SANDRA
Last Name:BERMAN
Suffix:
Gender:F
Credentials:EDD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 LAGO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3348
Mailing Address - Country:US
Mailing Address - Phone:727-784-8392
Mailing Address - Fax:727-784-8392
Practice Address - Street 1:1712 LAGO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3348
Practice Address - Country:US
Practice Address - Phone:727-784-8392
Practice Address - Fax:727-784-8392
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3990103TC0700X
FLPY6951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
31124508300OtherBWC
311245083Medicare UPIN
31124508300OtherBWC